Surgical aspects of pneumatosis cystoides intestinalis: two case reports

INTRODUCTION: Pneumatosis cystoides intestinalis is a rare disease usually caused by an underlying condition. It is defined as air filled cysts within the wall of the gastrointestinal tract. The purpose of this paper is the development of an algorithm for the surgical therapy of PCI based one two case reports. CASE PRESENTATIONS: A 17-year-old girl with Down syndrome and leucopenia due to chemotherapy for acute lymphatic leukemia was admitted with acute septic conditions and PCI. Explorative laparotomy revealed acute ischemia of the right colon and resection of the affected intestine was performed. After a short interval in the intensive care unit the patient was referred to the pediatric department. The second patient, a 79 year old man, with urothelial carcinoma and carcinoma of the prostate presented a distended abdomen. CT-scan revealed PCI and adhesive strangulation of intestines. Therefore only adhesiolysis was performed and PCI was treated conservatively. CONCLUSION: Only patients with increased inflammatory parameters in laboratory findings or signs of sepsis, peritonitis or bowel perforation in combination with PCI should receive an explorative laparotomy.